cmonfils | December 29, 2011
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Medicare expands resolution options to include a new Medicare repayment program for small settlements or judgments. This program will be available starting in February 2012 and applies to cases settling for $25,000 or less. Under this program, Medicare will provide final conditional payment amounts before settlement under certain circumstances. This program has the potential to revolutionize the settlement process for many Medicare beneficiaries, their counsel, and settling parties. The foundation of that process is to start the verification process early.
Category: CMS, Medicaid, Medicare |
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cmonfils | December 27, 2011
In a surprising move, the Department of Health and Human Services will not impose a uniform definition of “essential health benefits” (EHB) that individual and small group health insurance plans must provide in order to be offered on state exchanges starting in 2014.
Category: CHIP, Health Care Legislation, HHS, Medicaid, PPACA |
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cmonfils | December 27, 2011
www.myhealthguide.com
MyHealthGuide Source: Joanne Wojcik, 12/22/2011, Business Insurance SIIA Article
DETROIT — The Self-Insurance Institute of America Inc. has filed a lawsuit challenging a new Michigan law that is to start assessing a 1% tax on paid health care claims after Jan. 1, 2012.
The tax, which is being used to help fund the state’s Medicaid program, would be paid by insurers offering fully insured plans and by third-party claims administrators and stop-loss insurers in the case of self-funded plans. The assessment would be paid quarterly starting April 15, 2012. (more…)
Category: ERISA, Medicaid, Michigan, Self-Funding |
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cmonfils | December 15, 2011
The CMS said in a proposed rule that it recommends delaying data collection (PDF) in a reform law provision intended to expose financial relationships between drug and device manufacturers, GPOs and providers.
The agency said in the proposed rule that manufacturers and GPOs should not be required to start collecting information about their financial relationships with physicians and teaching hospitals on Jan. 1.
http://www.modernhealthcare.com/article/20111214/NEWS/312149973?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMZmFWdndGRWxiNUtpQzMyWmFwNW5nWUpidWk
Category: CMS, Health Care Legislation, Medicaid, Medicare |
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cmonfils | December 2, 2011
Now that the deficit-reduction supercommittee has failed to reach agreement, healthcare providers are dealing with the reality that things could get worse before they get worse.
A series of congressional hearings, intense lobbying efforts and countless closed-door meetings were not enough to help the 12-member Joint Select Committee on Deficit Reduction complete its task last week of delivering a proposal to Congress that identified ways to reduce the federal deficit by at least $1.2 trillion over the next 10 years. This summer’s Budget Control Act required that unless Congress could identify such savings, “sequestration” would kick in starting in January 2013, when $1.2 trillion in automatic, across-the-board cuts over 10 years will be split between defense and nondefense programs. The law limits the amount of healthcare savings by capping reductions to Medicare payments at 2%.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289960/cloudy-outlook
Category: Arizona, Health Care Legislation, Medicaid, Medicare, Pennsylvania, South Carolina |
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cmonfils | November 27, 2011
Nine of 10 leaders in health care and health care policy believe it is important for federal and state policymakers to continue to implement the Affordable Care Act, according to a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. Three-quarters of survey respondents think the growth in national health spending per capita can be lowered without harming access to or quality of care. Large majorities support implementation of specific coverage expansion provisions of the health reform law, including insurance market changes, Medicaid expansion, and premium tax credits. Leaders also believe it is important to implement payment and delivery system initiatives such as the Center for Medicare and Medicaid Innovation, Patient-Centered Outcomes Research Institute, and Independent Payment Advisory Board. Large majorities support key elements of President Obama’s recent framework to reduce the federal budget deficit by building on the law and achieving further savings in Medicare and Medicaid.
http://www.commonwealthfund.org/Publications/Data-Briefs/2011/Nov/Views-on-Health-Spending-and-Reform.aspx
Category: Health Care Legislation, Medicaid |
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cmonfils | September 16, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
In testimony before the House Subommittee on Oversight and Investigations on June 22, officials for the Centers for Medicare and Medicaid Services (CMS) defended how the Medicare Secondary Payer (MSP) program works, but GOP congressmen looked at billions of dollars of waste and gave CMS poor grades on tracking improper double payments. (more…)
Category: CMS, GAO, Medicaid, Medicare |
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cmonfils | September 16, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
This case involved the right of a state Medicaid agency to recover the Medicaid benefits paid for two individuals injured by third parties. Under federal law, when a Medicaid recipient settles with a tortfeasor for an amount less than the full damages suffered, Medicaid’s share of the settlement may not exceed the portion of the settlement that represents the Medicaid participant’s medical expenses. The court in this case ruled that the program would be limited to recovering discounted charges actually paid, and not the amount billed. But the court refused to eliminate the agency’s lien against future medical expenses the participant might incur that will be paid by Medicaid. (more…)
Category: Arizona, Arkansas, ERISA, Medicaid |
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cmonfils | September 16, 2011
www.modernhelathcare.com
By Jessica Zigmond
Posted: September 14, 2011 – 11:15 am ET Insurance, Medicaid, Medicare
Building on the Medicare Recovery Audit Contractor program, HHS on Wednesday issued a final rule to establish a Medicaid Recovery Audit Contractor program (PDF) that the agency expects will save $2.1 billion in waste over the next five years. (more…)
Category: HHS, Medicaid |
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cmonfils | August 30, 2011
www.modernhealthcare.com By Paul Barr August 1, 2011
Regardless of debt deal, healthcare likely to suffer
The protracted fight in Washington over raising the country’s debt ceiling and cutting its budget has shined a light on a poor federal reimbursement outlook for U.S. hospitals and health systems, regardless of how negotiations unfold. (more…)
Category: Health Care Legislation, Medicaid, Medicare |
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cmonfils | August 30, 2011
www.modernhealthcare.com By Rich Daly August 1, 2011
CMS’ actuaries: Healthcare spending will continue to increase, despite reform law promises
The landmark 2010 healthcare law will not slow the nation’s ballooning healthcare spending in the coming decade, and it will drive spending away from hospitals and toward physicians and pharmaceuticals, according to projections from the government’s healthcare actuaries. (more…)
Category: Accountable Care Organizations, Health Care Legislation, Medicaid, Medicare, Reimbursement |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
This case involved the right of a state Medicaid agency to recover the Medicaid benefits paid for two individuals injured by third parties. Under federal law, when a Medicaid recipient settles with a tortfeasor for an amount less than the full damages suffered, Medicaid’s share of the settlement may not exceed the portion of the settlement that represents the Medicaid participant’s medical expenses. The court in this case ruled that the program would be limited to recovering discounted charges actually paid, and not the amount billed. But the court refused to eliminate the agency’s lien against future medical expenses the participant might incur that will be paid by Medicaid. (more…)
Category: Medicaid |
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cmonfils | August 15, 2011
www.modernhealthcare.com By Rich Daly August 8, 2011
The newly enacted debt-ceiling deal may have saved the nation from a financial crisis, but it also managed to paint a target on the backs of healthcare providers. And the potential size and scope of the cuts they could face has providers scrambling for a response. (more…)
Category: Health Care Legislation, Medicaid, Medicare, Reimbursement, Texas, Washington |
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cmonfils | June 26, 2011
www.modernhealthcare.com By Rich Daly Posted: June 20, 2011 – 12:01 am ET
Reform law’s strict enforcement, tough penalties a slap in the face for some providers
As the 2010 federal healthcare overhaul was moving through Congress, provider groups knew that it contained an unprecedented series of penalties aimed at improving the quality of patient care and reducing inefficiencies in the healthcare system. But 2011 has brought those penalties into greater focus, as federal policymakers have begun to issue the regulations that spell out the extent of the financial toll on providers. (more…)
Category: Health Insurance, Medicaid, Medicare, Reimbursement |
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cmonfils | June 22, 2011
www.news.yahoo.com By RICARDO ALONSO-ZALDIVAR, Jun 21, 2001
WASHINGTON – President Barack Obama’s health care law would let several million middle-class people get nearly free insurance meant for the poor, a twist government number crunchers say they discovered only after the complex bill was signed. (more…)
Category: Health Care Legislation, Medicaid |
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